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Pulmonary Hypertension Medication: Outline of Pharmacological Therapy

In this article, we will be reviewing mainly about the advanced therapies which are available for pulmonary hypertension with the brief coverage of primary therapy. The advanced therapies are especially studied for IPAH.

PCSK9 Inhibitors – Lipid Control

Science has taught us that fats and cholesterols, despite their negative connotation, play a significant role in keeping ourselves in tiptop shape. From structural purposes to that of hormone production, lipids are an essential part of our body’s efforts to maintain homeostasis. However, problems do occur if there is an imbalance in the way that lipids are controlled by our system; this is where disorders such as the dyslipidemias come in. Fortunately, treatment modalities are also available to address this issue. In this case, it is important for us to understand the physiology of how our body maintains a healthy amount of lipids in order for us to gain some insight on how we approach patients with excessive lipid levels.

Fat Absorption and MTP Inhibitors: Orlistat and Lomitapide

The availability of fast food and the automation of most daily activities in our society today have predisposed the majority of the world’s population to obesity and its related complications. Although the intermittent nature of our food intake requires us to store carbohydrates, proteins and fats in excess, it is undeniable that resources, particularly those from developed countries, have proven our efforts in doing this somewhat excessive. Fortunately, there are a lot of treatment plans available for people who are already having problems with nutrient metabolism, particularly that of lipids. This includes medications that can hasten our efforts to maintain a healthy level of lipids in the body.

Lipid Control: HMG-CoA Reductase Inhibitors

Despite its negative connotation, cholesterol actually plays an important role in our body’s homeostasis. It basically makes up the most important parts which keeps us alive and functioning. For example, the membranes that keep our cells together are made up of cholesterol. However, major problems do arise when there is an alteration along its metabolic pathway in the body. For one, an excessive amount of cholesterol in the body has been linked to a lot of disorders, such as atherosclerosis and fatty liver disease. In this article, we will tackle how cholesterol is metabolized in the body and see where, in the pathway, HMG-CoA reductase inhibitors alter the whole process.

Lipid Control: Niacin, Bile Acid Sequestrants, Fibrates

From the name itself, lipoproteins are made up of complexes of lipids and proteins that primarily work as the transport system for cholesterol, triglycerides and other significant lipids needed by the body. Previously, the study of conditions related to problems in the metabolism of lipoproteins has been exclusive only for researchers focusing on lipids. However, it has been integrated into the inquiry of internists and other specialties as many researchers have provided a link between dyslipidemia and other highly prevalent conditions, such as atherosclerosis and fatty liver disease.

Vasodilators: Calcium Channel Blockers, Nitrodilators & More

Hypertension has consistently made its way to the leading causes of morbidity and mortality in recent years. Millions of deaths and disabilities are being documented worldwide because of its complications, such as cerebrovascular accidents and ischemia in various locations in the body. Despite its notorious nature, hypertension is preventable and controllable. This is made possible by making use of various pharmacologic managements that are available today. One of the most common medications used to control blood pressure is a direct vasodilator.

Postganglionic Sympathetic Nerve Terminal Blockers and Monoamine Oxidase Inhibitors

Every day, more and more people are being diagnosed with hypertension. This increase in prevalence worldwide can be attributed to non-modifiable factors other than heredity, age and sex. Without the incorporation of a healthy lifestyle and the promotion of wellness, it would not be shocking for someone to be put at a higher risk for developing complications brought about by the ‘silent killer’. Fortunately, there are already a lot of programs and campaigns that promote lifestyle modifications present in our society. As for the people already stricken with the disorder, many treatment programs are also already available and are tailor made to fit any patient. In connection to this, many drugs are developed to alleviate patients from high blood pressure.

Alpha Blockers: Mechanism of Action and Uses for Hypertension

Along with the automation of daily activities and improvement in the availability of food in our society, comes the increasing incidence of persons having chronic lifestyle diseases. One of the most prevalent of these is hypertension. It is also important to emphasize that this ‘silent killer’ is becoming more popular among younger populations nowadays. Fortunately, organizations have come up with ways to tackle this problem, including a wide variety of pharmacologic management that would help lower and maintain blood pressure. One of which is the use of α-adrenergic blockers.

Class 4: Calcium Channel Blockers – Antiarrhythmic Drugs

Calcium channel blockers have different scopes of application: they are used for the treatment of arterial hypertension or cardiac arrhythmia. Calcium channel blockers are also applied for the treatment of the coronary heart disease. They are often used if beta blockers cannot be applied due to intolerances or adverse effects.

Antihypertensives: ACE-Inhibitors and Sartans

The arterial hypertonia can be reduced with general measures often. However, medicinal approaches are also advisable in order to reach target blood pressures, which are in an area, as normal as possible. The most commonly prescribed drug are ACE-inhibitors, as they are cheap in price, followed by sartans. Both substances affect the renin-angiotensine-aldosterone system (RAAS) and reduce the blood pressure by the thereby conveyed effects.

Diuretics (Water Pills) — List of Drugs and Mechanism of Action

Diuretics promote the generation of a negative fluid balance in the body. Additionally, nearly all diuretics increase the excretion of sodium in the kidneys, so that water is linked osmotically and also excreted. The different diuretics affect different parts of the tubule system.

Thiazide Diuretics

Thiazide diuretics are some of the most common diuretics currently in use. Their mechanism of action involves inhibition of the Na/Cl co-transporter channel in the proximal part of the distal convoluted tubule, leading to increased sodium and chloride secretion. Their effects on reducing peripheral vascular resistance further contribute to their antihypertensive properties, in addition to their ability in decreasing effective blood volume. Besides hypertension, they are indicated for the treatment of heart failure exacerbation, hypercalciuria and diabetes insipidus. Important side effects include hypokalemia, hypercalcemia, hyponatremia, hyperglycemia, hyperuricemia and hypomagnesemia.

Loop Diuretics

Loop diuretics are one of the important classes of diuretics. Furosemide is the most commonly used loop diuretics. Other loop diuretics used are bumetanide, torasemide and ethacrynic acid. Loop diuretics are the most efficacious in causing diuresis in all the classes of diuretics. All the loop diuretics have the same mechanism of action, but different pharmacokinetic properties. They are used to treat/manage numerous diseases such as edema associated with CHF and liver cirrhosis. Diuretics most commonly cause electrolyte imbalance in the body on prolonged use.

Heart Failure Pharmacology: Aldosterone Antagonist (Antimineralocorticoid, MCRA)

Aldosterone antagonist are diuretic drugs that used in treatment of congestive heart failure or hypertension and increase survival rate in cardiac patients. They act at by competitive antagonism of mineralcorticoid receptors on the distal convoluting tubules and the upper collecting duct of the nephrons. They reduce the edema and workload on heart. Spironolactone is an important and widely used aldosterone antagonist. Other drugs in this category are eplerenone and finerenone.

Hypertension (High Blood Pressure, HBP) — Classification and Clinical Signs

With a prevalence of approximately 50 %, arterial hypertension is a very common disease. Blood pressure is a risk factor of secondary diseases such as stroke, CHD and cardiac insufficiency. Social connections as well as a relationship between hypertension, body weight and age are apparent. Many individuals with hypertension are not treated at all or receive insufficient therapy and, in many cases, are not aware they have the disease.

Class 2: Alpha and Beta Blockers – Antiarrhythmic Drugs

In this article, we will study the important pharmacological aspects of alpha and beta blockers such as classification, pharmacokinetics, mechanism of action, important actions on various organ systems, clinical uses and toxicity.

Class 3: Potassium Channel Blockers – Antiarrhythmic Drugs

The main role of antiarrhythmic agents is to prevent the occurrence of arrhythmia and, in the case of those patients in which abnormal rhythm has occurred; it helps in the termination of the arrhythmia. Antiarrhythmics are classified in various types by means of many classifications. The Vaughan-Williams classification is one of the widely accepted among those. Class 3 drugs constitute potassium channel blockers. These will be discussed in this article.

Class 1: Sodium Channel Blockers – Antiarrhythmic Drugs

The Vaughan-Williams classification is one of the most commonly used classifications for antiarrhythmic drugs. Class 1 consists of sodium channel blockers, which in turn is divided into 3 subgroups namely 1A, 1B and 1C. This article discusses the class 1 antiarrhythmic drugs in detail, along with a description of the salient features of individual drugs.

Anti-hypertensive Medications — List of Drugs and Lines of Therapy

Hypertension is the rise in blood pressure beyond the defined set point (conventionally ≥ 140/90 mmHg). Hypertension is the known risk factor for a number of cardiovascular events like myocardial infarction, angina and heart failure, sudden cardiac death. The pharmacological therapy for hypertension is discussed in this section. The therapies have evolved over time and the current line of therapy offers tremendous response and decreases the morbidity and mortality associated with this condition. It should be noted that non-pharmacological therapy like exercise and healthy food habits also play an important part in controlling hypertension.

Inotropes – Angina and Heart Failure Management

The inotropic agent in the context of heart failure and angina is classified into positive and negative inotropic agent. The positive agent increases the contractility and will be discussed in detail in this article. A brief about the negative inotropic agent, which decreases the myocardial contractility, is mentioned. The inotropic agent, when mentioned alone without any prefix, stands for a positive inotropic agent in this article.

Nitrates in the Treatment of Angina and Heart Failure

The organic nitrate includes drug like nitroglycerin, isosorbide mononitrate, and isosorbide dinitrate. The newer organic nitrate, which has recently been evaluated, is pentaerythrityl tetranitrate. The nitrates are available in various forms like intravenous, oral, sublingual, spray, ointment, patch, transdermal and buccal preparations.

Class 5: Other Antiarrhythmics – Antiarrhythmic Drugs

Miscellaneous antiarrhythmic drugs are those whose mechanism of action cannot be attributed to a single class of effect, and every drug inside the group acts by a different class of actions. This group of drugs isn't always the first line of treatment for many conditions, and their use is limited to few specific conditions.

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Day 37: Cardiovascular – Watch Videos and Review First Aid

Be prepared for the USMLE Step 1

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Your Educators of course Day 37: Cardiovascular – Watch Videos and Review First Aid

Lecturio USMLE

Pravin Shukle, MD

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